A unified framework for 3D radiation therapy and IMRT planning: plan optimization in the beamlet domain by constraining or regularizing the fluence map variations.

The purpose of this work is to demonstrate that physical constraints on fluence gradients in 3D radiation therapy (RT) planning can be incorporated into beamlet optimization explicitly by direct constraint on the spatial variation of the fluence maps or implicitly by using total-variation regularization (TVR). The former method forces the fluence to vary in accordance with the known form of a wedged field and latter encourages the fluence to take the known form of the wedged field by requiring the derivatives of the fluence maps to be piece-wise constant. The performances of the proposed methods are evaluated by using a brain cancer case and a head and neck case. It is found that both approaches are capable of providing clinically sensible 3D RT solutions with monotonically varying fluence maps. For currently available 3D RT delivery schemes based on the use of customized physical or dynamic wedges, constrained optimization seems to be more useful because the optimized fields are directly deliverable. Working in the beamlet domain provides a natural way to model the spatial variation of the beam fluence. The proposed methods take advantage of the fact that 3D RT is a special form of intensity-modulated radiation therapy (IMRT) and finds the optimal plan by searching for fields with a certain type of spatial variation. The approach provides a unified framework for 3D CRT and IMRT plan optimization.